Health Care Fiasco

The Role of Politicians and Non-Politicians in this Debacle

Part Two

By Gary F. Zeolla

      This two-part article is investigating the reasons for the Republican-controlled Congress’ inability to pass health care legislation. Part One considered the role Congress and President Trump are playing in this fiasco. This second part will consider the role non-politicians have in this debacle.

      But first, by way of reminder, the Democratic health care plan currently in force and which Republicans have been promising for seven years to repeal and replace is the Affordable Care Act (ACA), better known as Obamacare. The plan passed by the Republicans in the House is the American Health Care Act (AHCA). The plan the Republicans in the Senate are trying to pass is called the Better Care Reconciliation Act of 2017 (BCRA).

Individual Responsibility: The Way Out of This Mess

      There is a way out of the mess that is the US health care system. It is called individual responsibility, but that is what many Americans do not want. The health care fiasco is occurring because so many Americans are not willing to take personal responsibility for their own health and their own health care. And that is leading to a breakdown in the health care system in the USA. This lack of individual responsibility is seen on many levels.

Pre-existing Conditions

      As indicated in Part One, if there is a mandate by the government that pre-existing conditions must be covered, that will bankrupt any health care plan, if it enables people to wait until they get sick to purchase coverage. To be clear, by this I am referring to say a 20-something healthy male who chooses not to purchase health insurance, figuring he is healthy and unlikely to get sick or simply because he prefers to spend his money on something else. But then the unthinkable happens and that person gets in a serious car accident or is diagnosed with cancer or some such catastrophe.

      Treating his many injuries from an accident or for cancer can cost hundreds of thousands of dollars. But if he is allowed to purchase health insurance the day after his accident or cancer diagnosis, that means he will now be taking out of the system $100,000s without ever having paid anything into the system.

      And it is not just this one person. If a multitude of people take this approach and wait until they have a serious accident or get diagnosed with a serious illness to purchase coverage, you will have insurance companies being forced to shell out millions of dollars on care for people who never paid a penny into the system.

      Compounding the problem is that with the pre-existing conditions clause, many other young healthy people would also not purchase health insurance. Most of these young people will not get in a serious accident or develop a serious illness. However, that is the very reason why they need to be paying into the system. Their unused premium dollars are needed to pay for the high cost to treat people with serious health problems.

      Now many conservatives decry the idea that the well pay for those who are sick, but, as explained in Part One, that is how health insurance works, just as car insurance works by people who do not have car accidents paying for those who do.

      The ACA tried to evade this problem with its “individual mandate.” The purpose of this provision was to force everyone to purchase health insurance, whether they thought they needed it or not. But it had one basic flaw—it assumed that mandating people to do something would mean everyone would do it. But that is not what happened. 6.5 million people, mostly the young and healthy, chose to pay the penalty rather than purchase health insurance, as their premiums would have been far more than the penalty. Others simply ignored the law and paid nothing, as no matter how much the government might try, it cannot control what everyone does nor catch everyone who breaks the law and does not follow its mandates. And this lack of a sufficient number of young healthy people paying into the system is one reason Obamacare is failing.

      Both of the Republican plans eliminate the individual mandate. But their hope is their plans will so lower the premiums for health care that most of these people will chose to purchase it. In some cases, that will happen. People who did not purchase health care under the ACA might do so under the AHCA or the BCRA, if those plans are less expensive.

      This possibility is ignored by the Congressional Budget Office (CBO) and its estimates of how many people will lose their health insurance under the Republican plans as compared to the ACA. The CBO assumes if these people are not forced to buy health insurance, they will not do so. The CBO’s estimates are also based on predictions that more people will purchase health insurance under the ACA in the coming years and is using that as a “baseline” to compare coverage under ACA with the ACHA or BCRA. But such estimates are not reliable, making the CBO scoring of the Republicans plan useless.

      However, the media proclaims the CBO numbers as if they are reliable, and they are used to disparage the Republicans’ attempts to fix the health care crisis. Therefore, the CBO with its faulty numbers and the media are also partly to blame for the health care fiasco in Washington, as those faulty predictions have enraged the uninformed public, leading to them picketing against the Republican plans and the Republicans being reluctant about passing their own plans and incorporating in them what really needs to be done.

      Be that as it may, it is doubtful that a sufficient number of young, healthy people would purchase health insurance under either Republican plan to offset the millions that will be spent on people who develop serious and expensive health problems who do not have coverage but then expect to be covered.

      The answer to this dilemma is not to eliminate the whole idea of coverage for pre-existing conditions. It is true that it is totally unfair and unethical for somehow who has health insurance, develops a serious illness that is covered by that insurance, but then they need to change their plan for whatever reason (new job, moving, whatever) and to be told the condition they developed while covered under their previous plan will not be covered under their new plan.

      This is where the government does have a role to require the new insurance company to cover the condition that was developed and covered under the old plan. In such a case, the person was doing the right thing and had coverage and was paying into the system before developing the condition.

      The problem occurs when a person makes the choice to not to purchase health insurance for whatever reason then develops a serious health problem while not under any coverage. That person is in a far different position than the first. That person threw the dice and was betting he would not get sick and lost. As such, he should suffer the consequences of his choice, and others should not be forced to pay for his bad choice.

      Please note that I am not saying he should not get care. Of course he should. If someone is in an accident and is taken to an emergency room, he should receive treatment whether he has health insurance or not. Similarly, if someone is diagnosed with cancer, he should receive treatment whether he has health insurance or not. The difference is, he should have to pay for it out of his own pocket.

      It is true that most people do not have $100,000s in savings to cover the health care costs for such situations. That is why an intelligent person will purchase health insurance and why it is a very bad idea not to do so. But the person who makes that bad choice must be prepared to suffer the consequences.

      In this case, that means setting up a payment plan with the hospital and doctors to pay off the health care bill, just like he would set up a payment plan to pay for a new house or new car. It will just be one more monthly expense he will have to pay for many years to come, maybe for the rest of his life. If that means he has to lower his standard of living for the foreseeable future, so be it. That is the price he should pay for making a bad choice and is what individual responsibility means.

Coverage Mandates

      Related to the preceding is coverage mandates. Again, this refers to the government requiring that all health insurance plans cover specific conditions and preventative care. But it is those mandates that make health insurance prohibitively expensive and why many chose not to purchase it at all.

      However, my example 20-something healthy male does not need most preventive care. He does not need coverage for prostate problems, he does not need coverage for end-of-life care, he most certainly does not need maternity coverage or coverage for breast exams or pap smears. But one-size-fits-all health care requires coverage for all of these items, making his plan so expensive that he choices not purchase it.

      However, all such a person needs is “catastrophic insurance.” This is a bare bones insurance plan with a very high deductible, say $10,000. But after that deductible, it covers the full cost of treatment for serious health conditions like a car wreck or cancer. Now it is still true that most young people do not have even $10,0 00 in savings. But ten grand is far easier to repay than tens of thousands of dollars.

      But this is where individual reasonability again comes into play. Say my example person is also a teetotaler who does not use illicit drugs. As such, he chooses to purchase a plan that does not include alcohol and substance abuse treatment coverage. That make sense, and he should have the right to make such a choice.

      However, it is possible he might develop some kind of pain condition that requires him to take say Oxycodone, and he inadvertently gets addicted to it. Well again, he should get treatment, but then he should have to pay for it. He took a chance and betted he would never need substance abuse treatment and lost, so again, he should suffer the consequence of his choice, not others.

      The point is, each person should be free to choose the type of health care plan they think is best for themselves, without the government mandating what that plan entails. But it should be strongly advised (not mandated) that everyone get at least a bare-bones catastrophic plan.

      In this regard, another reason the CBO’s estimates of health care coverage should not be trusted is it only considers people to have health insurance if their plan has all of the currently mandated coverages. In other words, if under the AHCA or BCRA, someone choices to purchase only a catastrophic plan, that person is not considered to be covered by the CBO. That means the CBO’s estimate of non-coverage under the Republican’s plans is way overestimated, as such a plan is what many would choose to purchase, as it is all that they need.

      But once again, the media reports these estimates as if they are reliable, further inflaming the passions of the uniformed public, leading to more unjustified protests, making the Republican’s even more skittish about passing their own plans.

Keeping Freebies

      Another way many average Americans are partly to blame for the current health care fiasco is once a freebie is given out by the government, they are not willing to give it up. This is seen in the hysteria over the Republican plans reducing the limits to qualify for Medicaid. The media and the Democrats are proclaiming the Republicans are uncaring and want to kill poor people because of this plan. This media subterfuge is again leading to people picketing Republicans, making them skittish to pass their own plans and to not incorporate in them wants needs to be incorporated.

      But here are the facts: prior to the ACA, the limit to qualify for Medicaid was 350% of the poverty line, but the ACA increased it to 400%. Both Republican plans would reduce it back to 350%. That means those who are making from 350-400% of the poverty line would no longer qualify for Medicaid.

      The CBO assumes such people will not purchase health insurance on their own and thus would be uncovered, further inflating their estimates of non-coverage under the AHCA or BCRA. But again, the Republicans are assuming such people will purchase the less expensive plans under their systems.

      But where individual responsibility comes in is, people who are making 350-400% of the poverty line can afford at least a bare-bones health insurance plan if they budget for it. But they would prefer to have the government keep providing it for free, so they can spend their money elsewhere. Hence the picketing.

      To be clear, nobody is talking about taking coverage away from those who are truly in need and cannot afford coverage, no matter how much the media and Democrats might make it sound like that is the case. The Republicans are just trying to go back to the definition of “truly in need” which existed just seven years ago. But yet again, the media’s reports do not explain all of this, leading to yet more unnecessary protests and more hesitancy on the part of Republicans.

      The problem is, with the Obamacare limits, 74 million Americans are now covered under Medicaid, with fully half of all births in the USA being paid for by Medicaid. That number is truly staggering for what is supposed to be a safety net for the poor.

      That high number of people on Medicaid is due in part to the lackluster Obama economy, causing low wages and a low labor participation rate in the USA, but it is also due to expanding eligibility requirements. But when the Replicants in Congress try to reign in this expansion of Medicaid, they are labeled as not caring for the poor by both the media and Democrats.

      Underlying this problem is our society was better off when churches provided the safety net, not the government. With churches doing so, free health care was considered an act of grace, with gratitude given for it, whereas with the government providing it, it is considered an entitlement, with it being demanded. But Christians long ago abrogated their Biblical responsibility to care for the poor and the sick to the state (Matt 25:31-46).

Lifestyle Choices

      To return one last time to my car analogy from Part One, an old car repair shop advertisement said, “Pay me now, or pay me later.” If you don’t keep up with the upkeep on your car, eventually you will end up stranded somewhere, need to pay for a tow truck and then expensive car repair bills. Most Americans seem to understand this and keep up with the upkeep on their cars. In fact, most Americans take better care of their cars than their own bodies. And that leads to the last point under “individual responsibility.”

      The Standard American Diet, which, has the fitting acronym of SAD, contains a high proportion of highly processed foods. This leads to it being too high in unhealthy fatty foods, like processed meats, fried foods, and refined vegetables oils, and too high in sugar and other processed carbs, while being very low in fruits and vegetables, whole grain breads and cereals, nuts, fish, and other healthy foods.

      Add to this that only 20 percent of adults attain the recommend amounts of exercise, and it is no surprise two-thirds of Americans are overweight, with one-third being obesely so. And it is this poor diet, lack of exercise, and being overweight or obese that is at the root of our health care crisis.

      These poor lifestyle choices can lead to heart disease, cancer, stroke, type 2 diabetes, osteoporosis, and other health problems. And with so many Americans suffering from these very preventable and expensive diseases, our health care system is being stretched to the limit.

      The point is, as long Americans by large do not take care of their own health, then the health care crisis will never be solved in our country. There are just too many Americans who do not take responsibility for their own health. Instead, they think they can abuse their bodies, feeding it all kinds of junk, while never exercising, then when the inevitable health problems develop, they expect the health care industry to save them from themselves and their own self-abuse.

      Further details on the problems with the SAD and its relationship to degenerative diseases is found in my book Creationist Diet: Second Edition. But the bulk of that book is devoted to describing what a healthy diet is and how to incorporate changes into one’s own diet so to improve it and decrease one’s risk of these disease. My book God-given Foods Eating Plan provides similar information, though in a different fashion. It also contains a chapter on “Starting and Progressing in an exercise Program” for those who need help in that regard.

      One issue I address in the Creationist Diet book is that of cost. Yes, it is true that eating a healthy diet can be more expensive than a processed, fast food diet. But I give tips on reducing the cost in my book.

      Moreover, I also mention in that book that many food banks are now reclaiming produce that is often thrown away from farms and grocery stores because it doesn’t “look nice” but is perfectly fine to eat and are giving that out as part of their food giveaways for the poor. In fact, recently I received a newsletter from the Greater Pittsburgh Community Food Bank, which I support. It stated that the food bank is now committed to fully half of their food bags containing fresh fruits and vegetables. As such, the poor have no excuse not to eat fresh produce.

Adjusted Premiums

      You would think just being healthy and looking and feeling better would be enough incentive for Americans to take care of themselves. But that is obviously not the case. As such, what is needed is some kind of outside incentive. As one who believes in freedom and limited government, I am not advocating for the government to ban or even to tax junk food. As I have said repeatedly in this both parts of this article, people should have the right to make bad choices. But when they do, they must be prepared to suffer the consequences of those choices.

      Long-term, those consequences are the health problems poor health habits inevitably bring on. But given those health consequences are inevitable, before developing them, such a person should have to pay more for health insurance than those of us who make the effort to take care of ourselves.

      Of course, you cannot just ask someone how many servings of fruits and vegetables they consume a day, or how much they exercise. But there are simple tests that can be done to determine such.

      Bodyweight is the most obvious measure of how much someone is taking care of themselves, and there is no doubt people who are overweight are more likely to develop health problems than those who are of normal weight.

      But there is a caveat. It is not excessive bodyweight per se that increases one’s risk of health problems but excessive body fat. Those who are muscular due to being athletic might be considered overweight by a height/ weight chart or BMI but are in fact carrying very little body fat. In such cases, body fat percentage should be utilized. Methods to measure body fat percentage are discuss in both of my books.

      But in addition to body fat, other simple tests to reveal the state of a person’s health are: blood pressure, resting heart rate, blood lipid levels, and blood glucose levels. All of these are affected by diet and exercise. There are even blood tests for antioxidant levels that would indicate the degree to which someone is consuming fruits and vegetables.

      The results of these test could be used to adjust the premiums, so that those who are making an effort to take care of themselves should be given a break on their health insurance premiums, just as safe drivers are given a break on their car insurance premiums, while those who are not should have to pay more, just as the accident-prone must pay more for car insurance.

      By way of a qualifier, by the preceding I am in no way advocating higher premiums for those who suffer from health problems that are unrelated to lifestyle choices. For instance, I mentioned blood glucose levels. A high level can indicate type 2 diabetes. That is a condition that is directly related to lifestyle and can be control and even eliminated by lifestyle. On the other hand, type 1 diabetes, is a totally different condition that cannot be eliminated by lifestyle, as it is an inborn condition. As such, a distinction needs to be made between the two.

Health Care Co-ops

      Conservative commentator Sean Hannity on his TV and radio shows has spent much time over the last few years promoting the idea of health care co-ops. These are similar to food and other types of co-ops in that people join together to negotiate lower prices for products. But in this case, the co-op negotiates with health care providers for lower rates on basic health care services. The plan he mostly pushes is modeled after the co-op of Dr. Josh Umbehr, the founder of Wichita-based AtlasMD:

      At Atlas, patients pay a monthly membership fee — from $10 to $100 per month. Members have access to doctors in person, by phone or through social media channels.

      Patients don’t pay co-pays and aren’t charged extra for office visits. Medications typically cost “pennies on the pill,” Umbehr told Hannity.

      Imaging often is done at a lower cost through the Atlas model as well. Umbehr said an X-ray, for example, might cost an Atlas member $20 to $40 including radiology reads versus $100 or so at other clinics. Similar services might cost $500 to $1,000 through a hospital emergency room, Umbehr said (Wichita Business Journal).

      In other words, for a low monthly fee, members get their basic health care needs paid for by the co-op. This includes the various items mentioned in this two-part article, like annual physicals, flu shots, prostate exams, and other preventive services.

      However, catastrophic problems like a car accident or cancer are not covered. For that, members are encouraged to purchase a catastrophic health insurance plan. But the monthly premiums of the two together is still generally much lower than a standard health insurance plan. But the co-op plan has the advantage of taking advantage of the free market. The co-op can shop around and find the best prices for its member for basic services. That in turn forces health care providers to reign in their prices, leading to better access to health care for all.

      Sean often has members of Congress on his shows, and when the topic of health care comes up, which it often does of late, he always brings up this idea of co-ops. But the congressmen and women have never acted on this suggestion, and it has not been incorporated into either the AHCA or the BCRA. Senator Rand Paul is the only congressman I have heard even mention it. That is yet another sign that Congress just does not “get it” when it comes to what are the problems with our health care system. And that lack of understanding undergirds the fiasco in Washington DC.

Health Care Savings Accounts

      Health Care Savings Accounts (HCSAs) are another idea for covering basic health care costs, also to be coupled with a catastrophic insurance plan. Sean has also often mentioned this idea on his shows, and so have many Republicans in Congress, but strangely it is not incorporated into either Republican plan.

      There are different specifics on how such HCSAs would operate, but the one I favor is as follows: A HCSA would operate like an Individual Retirement Account (IRA) in that you can save money without paying taxes on it. It is a direct write-off on your federal income tax. But with an HCSA, when you take the money out, you do not pay taxes on it if you use the money towards health care, but you do pay taxes if you use it for any other purpose.

      The idea would be for a young person to begin to put money into a HCSA when he or she is young, just like they would put money into an IRA. Then as the money builds in the HCSA, they would have it for paying for basic preventative care like annual physicals, prostate exams, flu shots, and the like. The HCSA money would also be there to cover the deductible of a catastrophic plan if that should be needed.

      Of course, this idea depends on individual reasonability, but then, so does saving for retirement with an IRA. It is up to the young person to put away a little money each month into both an IRA and a HCSA. But once the idea gets ingrained into the culture, putting money into an HCSA would be just as natural as putting money into an IRA.

Congress’ Health Care Plan

      Part of the reason Congress doesn’t seem to get how much people are suffering under our current health care system is that they are not a part of it. When the Democrats passed the disaster known as Obamacare, they exempted themselves from it, and the Republican plans would do the same. Congress has its own “Cadillac” health care plan, fully paid for by taxpayers of course.

      If the politicians really want to understand what is happening, they should include in any health care bill that all members of Congress must participate in it and pay for it themselves. Maybe that will be the kick in the pants that will enable them to pass a plan that actually works.

      President Trump has even mentioned this issue, with warnings that he will force Congress to abide by their own health care laws. But it is unclear if he has the authority to do so.

Conclusion

      Individual reasonability and the free market are the answers to the health care crisis in the USA. But the politicians in Washington DC do not seem to have the know-how or political will to push for these solutions. As such, the fiasco will continue in Washington DC, while we the consumer of health care continue to suffer. But hopefully, this two-part article helped the reader to better understand the situation, so that you can put pressure on your representatives in Washington to pass a plan that incorporates the suggestions in this article.

Updates

      The preceding article was mostly written a week ago, when Part One was published (7/25/17). But since then a few events have happened that are worth adding to this article.

Single-Payer Proposal:

      On July 27, 2017, Republican Senator Steve Daines put forth an amendment to the BCRA to institute a single-payer health care system. He didn’t seriously want it to pass. It was just political gamesmanship to force Democrats to go on record as being for or against government controlled health care. Needless to say, not a single Republican voted for it, not even Daines himself. Only four Democrats voted for it, while 43 Democratic Senators voted “Present” not wanting to go on the record one way or the other.

      Even Bernie sanders, who had proposed a single-payer system in his White House run, voted “Present,” calling it “an old political trick.” And Bernie was right. That is all it was. Such gamesmanship does the American people no good, while exposing that politicians are more concerned about politics than the American people (The Atlantic).

      At 2:30 am on July 28, 2017, the Senate’s attempt to pass a “skinny repeal” of the ACA failed 49-51, with three Republican Senators voting against it, John McCain (AZ), Susan Collins (ME), and Lisa Murkowski (AK). It was called a “skinny” repeal, as it only would have eliminated the individual and business mandates and the taxes on health care devices of the ACA, while leaving the rest of Obamacare intact.

      However, this was yet another political trick, as it wasn’t designed to be signed into law. It was just to be a placeholder while a joint commission between the House and Senate worked on a true replacement bill. But that is the very reason John McCain says he voted against it; he didn’t trust that the skinny repeal would not be put into law (New York Post).

      What this means is the Republicans’ attempt to “repeal and replace Obamacare” is probably dead. They will now have to work with the Democrats and will probably have to drop that phrase and start talking about “fixing” the ACA. But it cannot be fixed, due to the in inherent flaws in it that have been discussed in this two-part article.

      Moreover, the Democrats will not go for the free market solutions discussed in this article. As such, the health care fiasco will continue, while the American people suffer.

      Meanwhile, McCain is back in Arizona to receive treatment for his newly diagnosed brain cancer. My prayers are with him, and I truly hope he is able to beat it, though it does not look good. But you can be sure he will get the best care possible. It is just sad that he did not see a way to ensure the same could be said for everyone else facing such a dire diagnosis.

      Conservative talk show host Mike Gallagher reported on his June 28^th radio show about a disturbing incident that happened in New York City. A married couple in their 50s living jumped out of their apartment building window to their deaths. The wife had a note in her pocket that read, “Our children are upstairs in our apartment. Please take care of them.” The husband had a note that read, “We both have health issues and cannot afford the medical bills.”

      This tragedy probably occurred just about the same time the skinny repeal was being voted down in the Senate. It shows this debate is not academic. It involves real people with real problems, and it is truly sad that the politicians cannot get their act together and end this fiasco by passing a health care plan that truly works for the average American.